E-099 Does Anterior Cerebral Artery Vasospasm after Spontaneous Subarachnoid Hemorrhage Predict Short Term Cognitive Outcome
Bibliographic record
Abstract
Background Spontaneous subarachnoid hemorrhage (SAH) is a disabling form of hemorrhagic stroke that affects young individuals and is responsible for short-term and long-term cognitive deficits. Delayed cerebral ischemia (DCI) is postulated to be the major determinant for this morbidity. Cerebral vasospasm (CVS) is a major contributor of DCI. Treatment of symptomatic CVS can consist of intra-arterial vasodilators or angioplasty. This study reports preliminary data on cognitive outcomes in a prospective cohort of patients with spontaneous SAH who received vasodilator therapy for anterior cerebral artery (ACA) vasospasm. Aim 1. Determine role of delayed cerebral ischemia (DCI) and CVS after spontaneous SAH on short-term cognitive outcome. 2. Determine if ACA vasospasm predicts short-term cognitive outcome. 3. Determine if treatment of ACA vasospasm results in improvement in short-term cognitive outcome. Methods Thirty-five patients with clinical follow-up at 3 months after SAH were selected from a prospective cohort. DCI was defined as a new hypodensity on CT scans located in a vascular territory, with or without symptoms (decrease of consciousness or focal deficits), due to CVS and not explained by other causes (e.g. rebleeding, hydrocephalus, cardioembolic sources, hypoxia, electrolyte disturbances, or seizures). CVS was defined as ≥25% narrowing on digital subtraction angiogram (aCVS) or Transcranial Doppler mean flow velocity ≥120 cm/sec (sCVS). Cognitive outcomes were assessed using Montreal Cognitive Outcome Assessment (MOCA) and poor cognitive outcome was defined as MOCA score <26. Fisher’s exact tests and logistic regression were performed to analyze the study questions. Results Average age of the study cohort was 53.1 ± 11.5 years with 71% of the patients being women. DCI occurred in 16/35 (45.7%) patients. In the absence of sCVS, DCI predicted poor cognitive outcomes (3/5 with DCI, 60% vs 1/10 without DCI, 10%; p = 0.04). Patients with anterior cerebral artery or anterior communicating complex (ACA/ACom) related aneurysmal SAH were less likely to have MOCA < 26 (ACA/ACom vs others (3/12, 25% vs 11/23, 47.8%; p = 0.28). Of the 22 patients who underwent digital subtraction angiogram for clinical indication, 10 were found to have ACA CVS and were treated. Patients with SAH due to ACA/ACom location aneurysms displayed low MOCA scores less often than those with SAH in other locations (2/5; 40% vs 4/5; 80%; p = 0.15). A two-factor logistic regression model found that, while holding treatment status constant, the odds of a poor cognitive outcome were 4.6 times higher (90% CI on odds ratio: 1.0, 21.3; p = 0.0998) among those with SAH outside of ACA/ACom aneurysms. Conclusions Our study reaffirms that occurrence of DCI after SAH predicts poor cognitive outcome at 3 months. The fact that cognitive outcomes were not superior in patients treated for CVS suggests that a complex pathophysiology determines outcomes after SAH. Relatively poor cognitive outcome among patients with SAH in locations other than ACA/ACom alludes to involvement of functional neural network apart from frontal lobe based networks that needs further investigation. Disclosures V. Pandav: None. B. Bohnstedt: None. L. Yearout: None. D. Thompson: None. B. Ray: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".